Modesty Issues

Cul2 · Mar 31, 2010

poetnyouknowit -- I reject the way you framed your question -- and that's a major part of the problem with discussing this issue. The right questions aren't being asked. I refer you to a study -- "Preferences for female and male nurses: the role of age, gender and previous experience -- year 2000 compared with 1984" by Anna Chur-Hansen BA PhD found in Journal of Advanced Nursing, 37(2), 192-98.

You're framing gender preference for patients assuming that all contexts are equal -- that is, having your vitals taken is equal to a pelvic exam, or what the anesthesia provider does compares equally with an extremely invasive intimate urological procedure. The study I quoted, rare for these kinds of studies, presents these kinds of scenarios to patients and not surprisingly, gender choice is connected to the context of the exam for men and women. Most of these kinds of studies don't consider context, and none that I can find ask why patients prefer one gender over another. You're simplifying a complicated human, psychological response. And, I must say, if this is such a contentious issue -- why do we just accept that most women today, esp. young women, prefer female doctors for intimate exams? Is there something wrong with these women? Are they in the stone age? Why is it so difficult to understand that a significant number of male and female patients prefer same gender care depending upon the context? I do understand that in a perfect world with perfect human beings, perhaps gender wouldn't matter. But this isn't a perfect world, people aren't perfect, and much research out there demonstrates that gender matters in many different contexts.

CaDad · Mar 31, 2010

Great Questions poet!!!For the family Doctor(s): Yes

*Daughter ( RN) and Wify have Their own female Doctor

*Son and I have our own Male Doctor

And just so everyone knows, there is a whole other matter for discussion regarding private practice, I can assure you they are having their own problems, so it is not just a hospital issue.

Other than intimate examinations or procedures, I or my family don't care.

You make very good points though on some earlier observations about context.

In my Humble opinion there is change happening, we cannot assume that the way it was done is going to stay the way it is. I for one, see change as a good thing. The Human condition is complex and encompasses the emotional and personal side as well. Once cannot work on one aspect and ignore the others, they all fit together and affect the outcome. A specific instance is the story told by ImaWonderer about her experience and the one about the young boy.

wahwahgerman · Apr 1, 2010

To wahwahgerman -- Everyone is different. They have different values and beliefs. Everyone isn't the same as you. Do you believe these differences should be respected? Or do believe in the "one size fits all" philosophy? To assume that people who don't see modesty the way you do are living in a stone age, is arrogant. I hope you're more open to different cultures and values that that. And again, we're dragged back into the ER. Most reasonable people will accept that emergencies are different situations. And, as you say, "Nurses are professionals, they provide privacy and promote dignity as much as possible regardless of gender." Although that's true, you need to be sensitive to patient feelings, beliefs, religions, cultural backgrounds, and possible sexual abuse history. It's more complicated that the stone age vs. "modern" times.

Agreed, everyone is different in their beliefs and preferences. But how do you suggest we accommodate these special requests? The reality is that the nurse who is on the schedule (or the nurse that has this particular patient under his/her care) will be in charge of doing caths and other cares related to genital areas. Do you think that hospitals should have male and female nurses on-call in case of a gender specific request? If the hospital can accommodate because they happen to have a nurse of each gender on-duty that is one thing, but suggesting that the option to request a specific gender of a nurse should always be available is unrealistic. It's not a question of sensitivity, it is a question of realistic situations in the world of nursing. There are not typically extra nurses just hanging around waiting for these types of requests....plenty of budget cuts and staffing cuts are going on in this financial atmosphere.

Editorial Team / Admin · Apr 1, 2010

Okay, let's talk about a scenario. Patient A is going to have a bowel resection, and will need a foley placed preop. Patient A has requested a male nurse. Currently the only male nurse working is scrubbed on a laparoscopic nephrectomy. Neither the circulating nurse nor scrub nurse assigned to Patient A has ever scrubbed a laparoscopic nephrectomy. Should the hospital send someone to relieve the male nurse and replace him with someone who is not competent for the case? Where would the line be drawn between Patient A's request for a male nurse and Patient B's right to have a competent nurse caring for them?

Let's use the scenario that hospitals should have an equitable ratio of male to female nurses. So should those applying be told that regardless of experience, references, education, etc. that the hospital is going to hire someone with less experience, not so great references, and less education simply because they need to balance the staff gender ratio? I'd refuse to work in such a facility, and they could (rightly so) be sued for discrimination.

A patient always has the right to take their business elsewhere, where providing them with the gender of nurse they prefer would not adversely affect the care given another patient.

Cul2 · Apr 1, 2010

Anyone can create a no-win scenario. In your specific scenario with Patients A and B -- of course, you go with what you've got. Patient safety always comes first. But, are you suggesting that the all or most gender requests are no-wins -- impossible to accommodate? Interesting. Because if that's the case, then let's be honest. Which gender doesn't get accommodated most of the time? If a female patient insists on a female nurse -- will that be a problem? Rarely if ever. Now, you'll say, this is the way it is in nursing. Okay, that's the reality. But let's just be honest about it. Admit it. Say it outloud. Women are or can be accommodated mostly, men are not or cannot be accommodated mostly. Men are not treated equally. There is no gender equity when it comes to respecting men who want their modesty.

And when you write this: "So should those applying be told that regardless of experience, references, education, etc. that the hospital is going to hire someone with less experience, not so great references, and less education simply because they need to balance the staff gender ratio?"

That's very interesting. You know, years ago, people wrote the same things about affirmative action and quotas. Did affirmative action for women result in the hiring more women of less experienced, not so great references, and less education? Was the result of affirmative action in the past less qualified minorities and women? I certainly don't think so.

What if patient A above said this to you: "Okay. Do what you have to do. I have no choice. But this is gender discrimination. I insist that you to put it in the chart that my request wasn't met and that, although I will go along with this because I have to for my own health, I do protest being treated this way." How would you respond to that?

Editorial Team / Admin · Apr 1, 2010

I never said it wasn't gender discrimination. Yes, women are accomodated more frequently, but they usually don't even need to ask because an all female team is what they have. As for the affirmative action, I was always taught that it was in the instance of two candidates of SIMILAR qualifications, the minority applicant would be hired. I'm talking two people with DISIMILAR qualifications. There isn't much difference between 1 year's experience and 14 months' experience, but there's a heck of a lot of difference between a new grad and someone with two year's experience.

When it comes to a patient stating gender discrimination, we have patient reps that can be called who are specially trained to handle such situations.

This has nothing to do with gender, but here's a true story from where I work. A male patient came in for a lap chole. Stated that he only wanted white staff to care for him. Hospital policies say no, we are not to accomodate this request. Surgeon hears about this. Tells the patient he will not do the surgery if he continues with this request. Why? He's discriminating against the staff, and wouldn't that kind of be what the patient is doing to a nurse when making a gender request?

Editorial Team / Admin · Apr 1, 2010

I'll add on here my personal requests for a specific gender:

-female surgical tech needing a lady partsl hyster, was nervous enough about being exposed to people she worked with

-40 something woman who had been sexually abused as a child

-woman whose religion (I think Islam but could be wrong) forbade anyone of the opposite gender other than her husband seeing her naked who had travelled quite some distance to be assured both a female surgeon and anesthesia provider

-15 year old rape victim requiring lady partsl repair

In nearly 5 years in the OR, I've never had a male patient ask for a male nurse. One comment that sticks out in my mind: "So you're the cute young thing that'll be handling my goods." What I said:"I will be providing your nursing care in the OR." What I was thinking: You're here to have genital warts lasered off your member. Why would I remotely enjoy handling your "goods"?

I imagine that it would be much easier to provide invasive care gender requests in units other than the OR. We're pretty much tied to a specific patient until we're either relieved or turn them over to PACU. A floor nurse can say to someone working with her but not her specific patient, "Can you put the foley in for John Smith? He requested a male to do it, and I'll be happy to return the favor should you need it."

morte, LPN, LVN · Apr 1, 2010

it would seem in elective surgery....anything that is NOT emergent....there could be some preplanning....??

CaDad · Apr 1, 2010

WOW-some pretty articulate and well founded o observations to be sure:

Unfortunately ,I agree with cul2. Males are generally discriminated against. They are lied to and given false information regarding the availability of males nurses ( or female nurses for female pts) when it comes to modesty or privacy issues because their request is simply considered needless and without merit. How dare a male or female have modesty issues, after all you have seen it all and it is nothing more than like changing a tire in a garage if your a mechanic. I have observed this countless times in Hospitals and Doctors offices I can assure you. And it is not just the invasive procedures or peri care either, its the total disregard for general privacy. I have observed Nursing staff exposing the pt to anyone and everyone while they are performing their duties and that is even more appalling! Imawonder stated she felt she could have had more privacy in the middle of a shopping mall...I can also tell you that many times inappropriate remarks are an attempt at levity to cover their discomfort in a very awkward situation. Just what would you have him say? Sooo how's the weather?And of course your absolutely right, we can and do just go somewhere else when we find out our requests cannot or will not be met. You might be supprised how often that is taking place. But there is a darker side to this, and I doubt poet will have any empathy either. There are a lot of males traumatized early in their youth (like the example given by ImaWonderer) that simply will not go back to a doctor or hospital unless they are darn near death. How would you feel if you had a son who severely injured himself and would not tell someone because he did not want to experience the humiliation again?It is that traumatizing!!! Contrary to popular belief ,the majority of males do not wish to expose themselves or flaunt their gentiles at any female coming near them! This absurd belief that males do not have modesty is one of those myths that just won't go away, its like the myth that every girl who dresses sexy wants to have sex-!!!! Pretty stupid stereotyping isn't it? We simply do not have professions where you can pretend to be androgynous. No matter how much you may want to, it is imposable to separate the physical side from the emotional side and they go hand in hand in pt's getting better. More and more studies are telling us that healing has a direct impact on the pt's sense of well being.

No one disputes that the situation is currently woefully inadequate in handling male requests, but accommodation when requested is something the pt deserves, after all, your suppose to be the pt's advocate aren't you? It is simply shocking that poet is so calloused in this regard. We simply need to fully appreciate the human condition and give the pt every consideration when it comes to their comfort in a very distressful situation.

ImaWonderer · Apr 1, 2010

OK so I have a question for anyone here who wants to take it. For those who work in the medical field WHY are modesty issues routinely made light of or dismissed. Lets be be clear i'm not specifically making reference to gender I mean modesty in general. I do not work in the medical field but I can easily understand a patient be embarrassed/humiliated by having their private parts exposed and being handled by strangers. I am NOT dismissing the need for the exam/procedure but WHY wont medical professionals at least ACKNOWLEDGE it as a legitimate issue.

I understand that most nurses/CNA's are female. But why are men who ADMIT and SPEAK OUT they are far more at ease w a man doing certain "intimate" procedures just dismissed. I am female and I am FAR more comfortable w women doing certain types of procedures/exams as a woman this is generally easily accommodated.(By the way if you read my original post I had my Modesty/Dignity VIOLATED by A WOMAN DOCTOR.)

The thing about this site and others as well is that medical professionals with patients ALWAYS have this "professional image" but when you hear them talk to each other you hear what they "really think" and really say once they leave your room. I think this is what patients worry about and know by the way.

Whenever a patient mentions an exact incident. I hear Oh well that doesnt happen....Ive been a nurse,CNA,Doctor for 20 plus years and Ive never seen a patient left uncovered.Or Where I work we never treat a patient this way.......my question is are the Patients making this up?

I believe that to a large extent working in this type of enviornment you do see patients in various degrees of undress( naturally) You do this everyday.....the difference is that the patient does not. If you as a medical professional took off your white coat and was handed the paper gown with the back out you would at least see things from the patient point of view. You would see things like staff not knocking on doors and walking in and out of the room differently, Curtains not being closed would affect you ,having your private parts handled in front of an audience would possibly humiliate you. Things like modesty,gender,dignity, privacy would be issues. If you have an embarrassing medical condition the patient is in a situation where they know the second the "medical person leaves your room" they are gossiping and giving details about EXACTLY what you did......

I would like to see modesty issues in general be addressed in medical facilities.There is some lip service given to it but I sense that it is routinely dismissed as trivial and quickly followed by......."no need to be embarassed "WE" see this all the time.........well great if you see it all the time but could you shut the door so the random people in the hallway dont have to see it?

Cul2 · Apr 1, 2010

First, I want to thank all of you for engaging in this issue. I know it's difficult, not an easy problem to solve the way things are today. I'm convinced most of you do your best to help both genders with modesty the best you can.

Second, to poetnyouknowit, you write: "A male patient came in for a lap chole. Stated that he only wanted white staff to care for him." You cannot compare overt racism and sexism to basic modesty issues. No argument, if a patient refuses a particular race due to racism, set that patient straight and refuse care. Same with sexism -- a woman who just hates men or a man who just hates women -- no care. But, as I've said, gender choices are often contextual -- not based on hatred of one gender or the other, and not based upon thinking that one gender is smarter or better qualified than another. The same patient who refuses a male or female for an intimate procedure, would probably not care one way or the other who takes his/her vitals or does non intimate work. Racism and sexism are not the same as gender choices for intimate procedures, the vast majority of the time.

Finally, I'm signing off this thread. I've made my points. And you all have made your points quite well. I respect where you're coming from, and admire the hard work you do and the difficult situations you come up against. This is not an easy problem to solve. All I ask, and you've provided it, is a fair, open discussion of this issue, and some attempt to come to grips with it, to improve the current situation. Keep up all the good work you do, all of you female and male nurses.

CaDad · Apr 1, 2010

Just a note: I work for a company that provides medical supplies to Hospitals and Private practice so I am in your environment everyday. I get a pretty wide overview on hospitals and private practice and as much exposure as I have had I am always supprised at what I experience daily. :uhoh3: